Does Your Postcode Determine Your Health?

Words by Dr Alexander Bowden

Photos by Natalie Su and Omer Rana

Many people see the humble postcode as a piece of personal information of little value. But, contrary to what you might expect, your postcode may provide more information about your health than your genetics.

In August 2016, I moved to one of Melbourne’s inner-northern suburbs. I became part of what one friend described as “the kale belt”, an area stretching from Brunswick, through Northcote, and down into Fitzroy, where health-conscious hipsters cycled from work to an evening yoga class.

By contrast, I soon started working at a medical clinic in Dandenong. I didn’t see many people riding bikes or walking the streets as I left work each day. As a GP, the privileged insights I gained into people’s lives, health issues, and their day-to-day concerns soon led me to believe that these two worlds were separated by more than just my commute.

“How many serves of vegetables do you eat a day?” is a screening question I often used to assess a patient’s diet. Sadly, this quickly became replaced with “how many times a week do you eat a vegetable?” There were other indicators too. An article published in the Herald Sun, on November 25 2016, proclaimed that Dandenong was the “unhappiest and unhealthiest suburb” in Melbourne, following the release of the VicHealth Indicators Survey 2015 report. So, why is a person living in Dandenong so much less likely to be healthy and happy than someone living in the “kale belt”? Research presented by Australia’s Health Tracker in 2017 might provide an answer.

Australia’s Health Tracker shows data relating to chronic diseases and their risk factors, illustrating their distribution by geographical area, and socioeconomic status. The latter is a measurement of the (unequal) distribution of ill health from the least, to most disadvantaged communities. Across almost every metric of health – risk factors, disease and mortality statistics – we see patterns of disease arranged along a gradient of social advantage. If you live in one of the most disadvantaged communities in Australia, you are two and a half times as likely to die from cardiovascular disease, one and a half times as likely to die from cancer, and more than one and a half times as likely to die from suicide, compared to those living in the most advantaged areas. Along this gradient of (dis)advantage, economic data suggests that things are unlikely to improve as the income gap between Australia’s wealthiest and poorest suburbs continues to widen.

To those of us who take an interest in personal health and the health of our communities, this message is far too grim. We can see that those most disadvantaged are the most affected by ill health, but they are also those least able to improve their situation. Too often I have heard people argue in favour of personal responsibility; that each individual is in charge of their own health by the behaviours that they choose. But once we understand that it is our food environments and physical environments – the social determinants of health – that shape our ability to be in good health, it becomes clear that medical advice to simply “make better choices” sounds as equally cruel and meaningless as advice like “don’t be poor”.

Photo by Natalie Su.

The informed contributions of policy makers, architects, planners and urban designers are essential to ensure that health, as well as environmental and economic benefits are maximised. It is absolutely critical that future opportunities are not forfeited through short-sighted decision making. Urban design can have enormous impact upon health and wellbeing. The World Health Organisation’s 2016 ‘Urban green spaces and health’ report suggests that green space in urban environments benefits both physical and mental well-being, particularly for socioeconomically disadvantaged communities. Green space is associated with better mental health, lower risk of cardiovascular disease, obesity, type 2 diabetes, and even improved pregnancy outcomes.

Transportation is another social determinant of health and thus there is a universal need for affordable access to transportation, including public transport, walking and cycling infrastructure. Effective public transport must be available, affordable, reliable and frequent. Adequate, well designed public transport networks enable people of all ages to be more socially engaged and connected. Walkways and bicycle paths encourage physical activity. Good urban design facilitates social interaction and provide spaces where people feel safe and can interact with each other, ultimately improving the connectedness of the entire community.

Connectedness then also provides the fertile soils necessary for community events and activities to grow. Many of these have explicit benefits for health and wellbeing, such as community gardens, produce markets and food co-operatives. Access to fresh fruit and vegetables is a key determinant for health, and for many, access is intimately linked to affordability. Local community action can go a long way to overcoming some of these challenges.

To achieve better health for individuals we need to look beyond traditional, individualistic ideas of healthcare and examine the health inequalities written in our postcodes. Health doesn’t happen in our hospitals or at a GP’s office, it happens in our communities. Sir Michael Marmot, a professor of epidemiology and public health at University College London, distilled this concept down to a simple question: “Why treat people and send them back to the conditions that made them sick?” We are all responsible for creating healthier communities.

"To achieve better health for individuals we need to look beyond traditional, individualistic ideas of healthcare and examine the health inequalities written in our postcodes."

Dr Alexander Bowden is a Melbourne-based GP with an interest in the social determinants of health, especially diet-related disease. He believes that access to healthy, fresh, real food is a fundamental requirement for good health, and is passionate about inspiring and empowering people to reclaim their health through cooking and eating good food.

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